Subcutaneous Blinatumomab Plus Ponatinib for BCR-ABL+ B-ALL

Inclusion Criteria:

1. Ph positive \[either t(9;22) and/or BCR-ABL1 positive\] ALL, CD19 positive
2. Age ≥18 years at time of informed consent
3. No prior induction treatment for ALL. A brief corticosteroid pre-phase (\< 1 week), or hydroxyurea for cytoreduction or symptom control is permitted.

3\. Greater than or equal to 5% blasts in the BM.

4\. Performance status ≤2 (ECOG Scale, see Appendix IV)

5\. Adequate organ function: 5.1.5.1 Hepatic:

Adequate liver function as defined by the following criteria (unless the increased values are judged to be leukemia disease related):

Total serum bilirubin less than 2 x upper limit of normal (ULN), unless due to Gilbert's syndrome or Meulengracht disease Alanine aminotransferase (ALT) less than 3 x ULN Aspartate aminotransferase (AST) less than 3 x ULN 5.1.5.2 Pancreatic:

* Serum lipase less than 2 x ULN 5.1.5.3 Renal:
* Estimated Creatinine clearance ≥ 40 mL/min 5.1.5.4 Cardiac:
* Left ventricular ejection fraction \> 40%

Exclusion Criteria:

1. Uncontrolled infection
2. Known infection with human immunodeficiency virus (HIV) or chronic infection with hepatitis B virus or hepatitis C virus
3. Presence of cardiovascular disease of clinical relevance within the past 3 months. This includes:

   5.2.3.1 Unstable angina 5.2.3.2 Myocardial infarction 5.2.3.3 Transient ischemic attack or stroke 5.2.3.4 Peripheral vascular infarction, claudication and/or revascularization 5.2.3.5 Symptomatic congestive heart failure 5.2.3.6 Clinically significant significant atrial/ventricular tachyarrhythmias 5.2.3.7 Venous thromboembolic event requiring systemic anticoagulation

   Please consult the sponsor if there are specific concerns outside of these criteria
4. Uncontrolled hypertension
5. History or presence of clinically relevant CNS pathology or event.

   This may include, for example:

   epilepsy, childhood or adult seizure, paresis, aphasia, stroke, severe brain injuries, dementia, Parkinson's disease, cerebellar disease, organic brain syndrome or psychosis.

   Before excluding a potential subject, please consult the sponsor.
6. Any other concurrent disease or medical condition that could be exacerbated by the treatment or would seriously complicate compliance with the protocol.
7. History of malignancy other than ALL within 3 years prior to start of protocol-specified therapy except for:

   * malignancy treated with curative intent and with no known active disease present for 3 years before enrollment, and felt to be at low risk for recurrence by the treating physician
   * adequately treated non-melanoma skin cancer or lentigo maligna without evidence of disease
   * adequately treated cervical carcinoma in situ without evidence of disease
   * adequately treated breast ductal carcinoma in situ without evidence of disease
   * prostatic intraepithelial neoplasia without evidence of prostate cancer
8. Prior hematologic malignancy and/or alloSCT; this includes known CML
9. Concurrent or prior (within 30 days) treatment with another investigational agent or study drug
10. Female subject is pregnant or breastfeeding or planning to become pregnant breastfeed during treatment, and for an additional 4 months after the last dose of protocol-specified therapy
11. Inability to swallow or absorb tablets
12. Subject considered unsuitable for study for any other reason in the physician's best judgement. Before excluding a potential subject, please consult the sponsor.